Active NPI
Scott Ray Blackstock, PHARMD
- Pharmacist
- Tavares, FL
National Provider Identifier
1134859424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS64010
- Practice address
- 680 E Burleigh Blvd
Tavares, FL 32778-2208 - Phone
- (352) 253-0289
- NPI assigned
- Jun 10, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS64010 | FL | Primary |
Addresses
Primary practice location
680 E Burleigh Blvd
Tavares, FL 32778-2208
Mailing address
2015 Leah Star Rd
Astor, FL 32102-6915
Phone (772) 453-7766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS64010 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
680 E Burleigh Blvd
Tavares, FL 32778
Phone (352) 253-0289
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Tavares, FL
- NPI 1144466335
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- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654819200000",
"number": "1134859424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2015 LEAH STAR RD",
"city": "ASTOR",
"state": "FL",
"postal_code": "321026915",
"telephone_number": "772-453-7766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 E BURLEIGH BLVD",
"city": "TAVARES",
"state": "FL",
"postal_code": "327782208",
"telephone_number": "352-253-0289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKSTOCK",
"first_name": "SCOTT",
"middle_name": "RAY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-10",
"last_updated": "2022-06-10",
"certification_date": "2022-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS64010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.